[Music] hello friends hi i'm dr shanali chandra and i welcome you all to our youtube channel medicine decoded now in this small video i'm going to show you obstetric examination now before you examine a patient make sure that you explain to the patient what you're going to do all right so take a verbal consent and at the same time you know make the patient lie down for examination after she passes urine right so ask her to empty the bladder because you see full bladder will interfere with your interpretation of the fundal height or the size of the uterus because uh if the bladder is full it pushes the uterus upwards then you might get a falsely a high falsely high estimation of bundle height now make the patient feel comfortable be comfortable while she is being examined and also yes while you're positioning the patient keep in mind that you are going to examine the patient standing on the right side of the patient and the abdomen is exposed fully right from the pubic surfaces to the suture sternum this entire area and the rest of the area should be properly covered you know and uh patient is in the dorsal supine position like this right so the patient's head is on this side feet are on this side i'm standing to the right side of the patient okay and the hips and the knees are slightly flexed here and the knees are wide apart uh that allows for the relaxation of the abdominal muscle now also keep in mind that sometimes the uterus may be tilted towards one side or the other side okay so most of the times it is tilted towards the right side like this texture rotate it so before you start palpating for the fundal height assessment make sure that you correct this tilt you correct the text to rotation and standing on the right side of the patient you can you know tilt the uterus like this stabilize it like this and then go on to estimate the fundal height so keep this in mind here one more important point before palpation centralize the uterus now in this video the patient that i'm performing the obstetric examination on is a term patient so let us begin the patient is in dorsal supine position with knees and hips flexed and knees wide apart so describing the inspection findings this is the pubic symphysis and look at the avoid bulge seems the fetus is longitudinally aligned and you can see the umbilicus is central and everted and you can see these uh striagravidarum which are the stretch marks and you can also see this deep line of pigmentation you see extending from the umbilicus to the pubic symphysis and this is called as the linear [ __ ] and these are the striagravaderum and you can see that the overlying skin is healthy there is no scar mark of any kind indicating of any previous surgery now for palpation from symphysis pubis to umbilicus we divide into two equal parts if fundus is here midway between the umbilicus and pubic symphysis bundle height is 16 weeks if the fundus is at umblicus then the fundal height is 24 weeks now this is iffy sternum from zifi standard to umbilicus we divide into three equal parts till here it is 28 weeks till here 32 weeks and all the way up to zifistandam it's 36 weeks now to see the fundal height we start palpating from the zifi star numb using the ulnar border of our hand and see where we feel the fundus so this is 32 weeks but the patient is term why so because the flanks are full bulk of the baby is in the flags when the head goes down to the pelvis flanks are occupied by the baby's body so this is 32 weeks with flanks full so this is a term size uterus and now let us mark the fundal height by using a pen so now to measure the simphiso fundal height in centimeters we will have to ask the woman to straighten her legs first so let's ask her to straighten the legs and we take the inch tape here now the centimeter side should be away from our vision and the inches side should be facing you so this is the pubic symphysis fubis here and i place the inch tape here and then take it up to the mark which i had put right so the inches is towards me and i turn it over this is 32 this is 32 centimeters so 32 centimeters is our symphysia fundal height in centimeters and with flanks full okay let's see it again measuring the simphiso fundal height see the centimeters side is away from your vision this is 32 centimeters simplifies to fundal height with flanks full so this is a term size uterus now we have to do the leupold's maneuvers the obstetric grips for that you have to ask the woman to flex her knees and hips again with the knees wide apart and that relaxes the abdominal muscles now the first three grips are done facing the patient so checking the fundal grip now i am palpating broad soft part like the buttocks and then for the lateral grips you stabilize with one hand on one side and then do the grip on the other side like i am here palpating the right side of the mother so this is the right lateral grip you look more closely here i am feeling knobby parts on the right side of the mother suggestive of fetal limbs and on the left side i'm feeling a curved part which is suggestive of the fetal back side now for the third grip that is the polygrip we use one hand we use one hand to grasp the presenting part now if the head is free it is blottable but here the head is not free now for the fourth grip which is the pelvic grip right we face the patient's legs okay and we take the two hands and try to dig here you know below the presenting part we try to go beneath the presenting part with both our hands parallel to the inguinal ligament as you can see okay but my two hands are not converging below the presenting part right that means that the head has gone deep into the pelvis okay that means that the head is most likely engaged now let us palpate the contractions okay now for that you have to place one hand on the woman's fundus here and then feel feel the uterus so like here the uterus is relaxed because i'm able to indent the uterine wall with gentle pressure by my fingers here but when the uterus is contracted and this hardening of the uterus this indentation of the wall of the uterus will not be possible okay and the woman will complain of pain so what did we see here are the buttocks head is here back is here on left side limbs here on right side so longitudinal like a phallic presentation back on the left side so occiput is also on the left side so this is left occipital position it could be transverse or anterior left occipital transfer or left occipital anterior we don't know as of right now in the confirmation of loa or lot or for that matter occiput or posterior position will eventually be done by the pv examination but the position of the fetal heart sound where the fetal heart sound is heard with maximum intensity will give us a very good idea about the position in anterior position fetal heart rate is best heard anteriorly in occipital posterior position fetal heart rate is best heard at the flanks should i auscultate here no i will auscultate here because fetal heart sounds are best heard transmitted from the fetal back side so in this case on the left side so where exactly should be auscultated now this is the umbilicus and this is the anterior square ilex spine now between these two points let us imagine a spino um like a line and midpoint here of this line here is where one should auscultate for the fetal heart sound so let me auscultate here now as the head goes down into the pelvis you see the fetal heart rate also moves towards the midline and downwards now i can hear it here best this means the head has gone down deep into the pelvis and it is loa position left occipital anterior now let us here with doppler and auscultate for full one minute and remember as the head goes down deep into the pelvis the fetal heart rate moves more towards the center and downwards so at the end of this examination we can conclude that this is a term-sized relaxed uterus with cephalic presentation in loa position left occipital anterior position [Music] you